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Herbers C, Zhang R, Erdman A, Johnson MD. Distinguishing features of Parkinson's disease fallers based on wireless insole plantar pressure monitoring. NPJ Parkinsons Dis 2024; 10:67. [PMID: 38503777 PMCID: PMC10951221 DOI: 10.1038/s41531-024-00678-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 03/07/2024] [Indexed: 03/21/2024] Open
Abstract
Postural instability is one of the most disabling motor signs of Parkinson's disease (PD) and often underlies an increased likelihood of falling and loss of independence. Current clinical assessments of PD-related postural instability are based on a retropulsion test, which introduces human error and only evaluates reactive balance. There is an unmet need for objective, multi-dimensional assessments of postural instability that directly reflect activities of daily living in which individuals may experience postural instability. In this study, we trained machine-learning models on insole plantar pressure data from 111 participants (44 with PD and 67 controls) as they performed simulated static and active postural tasks of activities that often occur during daily living. Models accurately classified PD from young controls (area under the curve (AUC) 0.99+/- 0.00), PD from age-matched controls (AUC 0.99+/- 0.01), and PD fallers from PD non-fallers (AUC 0.91+/- 0.08). Utilizing features from both static and active postural tasks significantly improved classification performances, and all tasks were useful for separating PD from controls; however, tasks with higher postural threats were preferred for separating PD fallers from PD non-fallers.
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Affiliation(s)
- Cara Herbers
- Department of Mechanical Engineering, University of Minnesota, 111 Church Street SE, Minneapolis, 55455, MN, USA
| | - Raymond Zhang
- Department of Biomedical Engineering, University of Minnesota, 312 Church Street SE, Minneapolis, 55455, MN, USA
| | - Arthur Erdman
- Department of Mechanical Engineering, University of Minnesota, 111 Church Street SE, Minneapolis, 55455, MN, USA
| | - Matthew D Johnson
- Department of Biomedical Engineering, University of Minnesota, 312 Church Street SE, Minneapolis, 55455, MN, USA.
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Araújo HAGO, Smaili SM, Morris R, Graham L, Das J, McDonald C, Walker R, Stuart S, Vitório R. Combination of Clinical and Gait Measures to Classify Fallers and Non-Fallers in Parkinson's Disease. SENSORS (BASEL, SWITZERLAND) 2023; 23:4651. [PMID: 37430565 DOI: 10.3390/s23104651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/03/2023] [Accepted: 05/08/2023] [Indexed: 07/12/2023]
Abstract
Although the multifactorial nature of falls in Parkinson's disease (PD) is well described, optimal assessment for the identification of fallers remains unclear. Thus, we aimed to identify clinical and objective gait measures that best discriminate fallers from non-fallers in PD, with suggestions of optimal cutoff scores. METHODS Individuals with mild-to-moderate PD were classified as fallers (n = 31) or non-fallers (n = 96) based on the previous 12 months' falls. Clinical measures (demographic, motor, cognitive and patient-reported outcomes) were assessed with standard scales/tests, and gait parameters were derived from wearable inertial sensors (Mobility Lab v2); participants walked overground, at a self-selected speed, for 2 min under single and dual-task walking conditions (maximum forward digit span). Receiver operating characteristic curve analysis identified measures (separately and in combination) that best discriminate fallers from non-fallers; we calculated the area under the curve (AUC) and identified optimal cutoff scores (i.e., point closest-to-(0,1) corner). RESULTS Single gait and clinical measures that best classified fallers were foot strike angle (AUC = 0.728; cutoff = 14.07°) and the Falls Efficacy Scale International (FES-I; AUC = 0.716, cutoff = 25.5), respectively. Combinations of clinical + gait measures had higher AUCs than combinations of clinical-only or gait-only measures. The best performing combination included the FES-I score, New Freezing of Gait Questionnaire score, foot strike angle and trunk transverse range of motion (AUC = 0.85). CONCLUSION Multiple clinical and gait aspects must be considered for the classification of fallers and non-fallers in PD.
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Affiliation(s)
- Hayslenne A G O Araújo
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
- Department of Physical Therapy, State University of Londrina, Londrina 86057-970, Brazil
| | - Suhaila M Smaili
- Department of Physical Therapy, State University of Londrina, Londrina 86057-970, Brazil
| | - Rosie Morris
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Newcastle upon Tyne NE29 8NH, UK
| | - Lisa Graham
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
- Gateshead Health NHS Foundation Trust, Gateshead NE8 2PJ, UK
| | - Julia Das
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Newcastle upon Tyne NE29 8NH, UK
| | - Claire McDonald
- Gateshead Health NHS Foundation Trust, Gateshead NE8 2PJ, UK
| | - Richard Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Newcastle upon Tyne NE29 8NH, UK
| | - Samuel Stuart
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Newcastle upon Tyne NE29 8NH, UK
- Department of Neurology, Oregon Health and Science University, Portland, OR 97239, USA
| | - Rodrigo Vitório
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
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Vitorio R, Mancini M, Carlson-Kuhta P, Horak FB, Shah VV. Should we use both clinical and mobility measures to identify fallers in Parkinson's disease? Parkinsonism Relat Disord 2023; 106:105235. [PMID: 36512851 PMCID: PMC10756255 DOI: 10.1016/j.parkreldis.2022.105235] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/09/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although much is known about the multifactorial nature of falls in Parkinson's disease (PD), optimal classification of fallers remains unclear. OBJECTIVE To identify clinical (demographic, motor, cognitive and patient-reported) and objective mobility (balance and gait) measures that best discriminate fallers from non-fallers in PD. METHODS People with mild-to-moderate idiopathic PD were classified as fallers (at least one fall; n = 54) or non-fallers (n = 90) based on previous six months falls. Clinical characteristics included demographic, motor and cognitive status and patient-reported outcomes. Mobility (balance and gait) characteristics were derived from body-worn, inertial sensors while performing walking and standing tasks. To investigate the combinations of (up to four) measures that best discriminate fallers from non-fallers in each scenario (i.e., clinical-only, mobility-only and combined clinical + mobility models), we applied logistic regression employing a 'best subsets selection strategy' with a 5-fold cross validation, and calculated the area under the curve (AUC). RESULTS The highest AUCs for the clinical-only, mobility-only and clinical + mobility models were 0.89, 0.88, and 0.94, respectively. The most consistently selected measures in the top-10 ranked models were freezing of gait status (8x), the root mean square of anterior-posterior trunk acceleration while standing on a foam with eyes open (5x), gait double support duration (4x) and the postural instability and gait disorders score from the MDS UPDRS (4x). CONCLUSIONS Findings highlight the importance of considering multiple aspects of clinical as well as objective balance and gait characteristics for the classification of fallers and non-fallers in PD.
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Affiliation(s)
- Rodrigo Vitorio
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA; Department of Sport, Exercise & Rehabilitation, Northumbria University, UK
| | - Martina Mancini
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | | | - Fay B Horak
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA; APDM Wearable Technologies, a Clario Company, Portland, OR, USA
| | - Vrutangkumar V Shah
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA; APDM Wearable Technologies, a Clario Company, Portland, OR, USA.
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Cutoff Point of Mini-Balance Evaluation Systems Test Scores for Elderly Estimated by Center of Pressure Measurements by Linear Regression and Decision Tree Classification. LIFE (BASEL, SWITZERLAND) 2022; 12:life12122133. [PMID: 36556499 PMCID: PMC9784881 DOI: 10.3390/life12122133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/11/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Understanding balance ability and assessing the risk of possible falls are very important for elderly rehabilitation. The Mini-Balanced Evaluation System Test (Mini-BESTest) is an important survey for older adults to evaluate subject balance, but it is not easy to complete due to various limitations of physical activities, including occasional fear of injury. A center of pressure (CoP) signal can be extracted from a force pressure plate with a short recording time, and it is relatively achievable to ask subjects to stand on a force pressure plate in a clinical environment. The goal of this study is to estimate the cutoff score of Mini-BESTest scores from CoP data. METHODS CoP signals from a human balance evaluation database with data from 75 people were used. Time domain, frequency domain, and nonlinear domain parameters of 60 s CoP signals were extracted to classify different cutoff point scores for both linear regression and a decision tree algorithm. Classification performances were evaluated by accuracy and area under a receiver operating characteristic curve. RESULTS The correlation coefficient between real and estimated Mini-BESTest scores by linear regression is 0.16. Instead of linear regression, binary classification accuracy above or below a cutoff point score was developed to examine the CoP classification performance for Mini-BESTest scores. The decision tree algorithm is superior to regression analysis among scores from 16 to 20. The highest area under the curve is 0.76 at a cutoff point score of 21 for the CoP measurement condition of eyes opened on the foam, and the corresponding classification accuracy is 76.15%. CONCLUSIONS CoP measurement is a potential tool to estimate corresponding balance and fall survey scores for elderly rehabilitation and is useful for clinical users.
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Student J, Engel D, Timmermann L, Bremmer F, Waldthaler J. Visual Perturbation Suggests Increased Effort to Maintain Balance in Early Stages of Parkinson’s to be an Effect of Age Rather Than Disease. Front Hum Neurosci 2022; 16:762380. [PMID: 35308620 PMCID: PMC8924037 DOI: 10.3389/fnhum.2022.762380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 02/02/2022] [Indexed: 12/01/2022] Open
Abstract
Postural instability marks a prevalent symptom of Parkinson’s disease (PD). It often manifests in increased body sway, which is commonly assessed by tracking the Center of Pressure (CoP). Yet, in terms of postural control, the body’s Center of Mass (CoM), and not CoP is what is regulated in a gravitational field. The aim of this study was to explore the effect of early- to mid-stage PD on these measures of postural control in response to unpredictable visual perturbations. We investigated three cohorts: (i) 18 patients with early to mid-stage PD [Hoehn & Yahr stage (1–3); 1.94 ± 0.70]; (ii) a group of 15 age-matched controls (ECT); and (iii) a group of 12 young healthy adults (YCT). Participants stood on a force plate to track their CoP, while the movement of their entire body was recorded with a video-based motion tracking system to monitor their CoM. A moving room paradigm was applied through a head-mounted virtual reality headset. The stimulus consisted of a virtual tunnel that stretched in the anterior-posterior direction which either remained static or moved back and forth in an unpredictable fashion.We found differences in mean sway amplitude (MSA) and mean velocities of CoP and CoM between the groups under both conditions, with higher MSA of CoP and CoM for PD and higher mean velocities of both variables for PD and ECT when compared with YCT. Visual perturbation increased mean CoP velocity in all groups but did not have effects on mean CoM velocity or MSA. While being significantly lower for the young adults, the net effect of visual perturbation on mean CoP velocity was similar between patients with PD and age-matched controls. There was no effect of the visual perturbation on mean CoM velocity for any of the groups.Our simultaneous assessment of CoP and CoM revealed that postural control is reflected differently in CoM and CoP. As the motion of CoM remained mostly unaffected, all groups successfully counteracted the perturbation and maintained their balance. Higher CoP velocity for PD and ECT revealed increased corrective motion needed to achieve this, which however was similar in both groups. Thus, our results suggest increased effort, expressed in CoP velocity, to be an effect of age rather than disease in earlier stages of PD.
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Affiliation(s)
- Justus Student
- Department of Neurophysics, University of Marburg, Marburg, Germany
- Department of Neurology, University Hospital of Marburg, Marburg, Germany
- *Correspondence: Justus Student
| | - David Engel
- Department of Neurophysics, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus-Liebig-University of Gießen, Marburg, Germany
| | - Lars Timmermann
- Department of Neurology, University Hospital of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus-Liebig-University of Gießen, Marburg, Germany
| | - Frank Bremmer
- Department of Neurophysics, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus-Liebig-University of Gießen, Marburg, Germany
| | - Josefine Waldthaler
- Department of Neurology, University Hospital of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus-Liebig-University of Gießen, Marburg, Germany
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Casal MZ, Peyré-Tartaruga LA, Zanardi APJ, Ivaniski-Mello A, Alves LDL, Haas AN, Martinez FG. Postural Adjustments and Biomechanics During Gait Initiation and Obstacle Negotiation: A Comparison Between Akinetic-Rigid and Hyperkinetic Parkinson's Disease. Front Physiol 2021; 12:723628. [PMID: 34803726 PMCID: PMC8600270 DOI: 10.3389/fphys.2021.723628] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Individuals with Parkinson's disease (PD) exhibit different combinations of motor symptoms. The most frequent subtypes are akinetic-rigid (AK-R) and hyperkinetic (HYP). Motor symptoms, such as rigidity and bradykinesia, can directly affect postural adjustments and performance in daily tasks, like gait initiation and obstacles negotiation, increasing the risk of falls and functional dependence. Objective: To compare postural adjustments and biomechanical parameters during the gait initiation and obstacle negotiation of people with AK-R and HYP PD and correlate with functional mobility and risk of falls. Methods: Cross-sectional study. Thirty-three volunteers with PD were divided into two groups according to clinical motor manifestations: AK-R (n = 16) and HYP (n = 17). We assessed the anticipatory (APA), compensatory (CPA) postural adjustments analyzing kinematic, kinetic and, electromyographic parameters during the gait initiation and obstacle negotiation tests. We applied independent T-tests and Pearson correlation tests for comparisons and correlations, respectively (α = 0.05). Results: In the APA phase of the gait initiation test, compared to the functional HYP group, the AK-R group showed shorter time for single support (p = 0.01), longer time for double support (p = 0.01) accompanied by a smaller first step (size, p = 0.05; height, p = 0.04), and reduced muscle activation of obliquus internus (p = 0.02). Similarly, during the first step in the obstacle negotiation test, the AK-R group showed less step height (p = 0.01) and hip excursion (p = 0.02), accompanied by a reduced mediolateral displacement of the center of pressure (p = 0.02) during APA, and activation of the gluteus medius (p = 0.02) and the anterior tibialis (p = 0.04) during CPA in comparison with HYP group. Conclusion: The findings suggest that people with AK-R present impaired postural adjustments during gait initiation and obstacles negotiation compared to hyperkinetic PD. Based on defined motor symptoms, the proposition presented here revealed consistent postural adjustments during complex tasks and, therefore, may offer new insights onto PD motor evaluation and neurorehabilitation.
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Affiliation(s)
- Marcela Zimmermann Casal
- Exercise Research Laboratory, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | | | | | - André Ivaniski-Mello
- Exercise Research Laboratory, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Lucas de Liz Alves
- Exercise Research Laboratory, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Aline Nogueira Haas
- Exercise Research Laboratory, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Flávia Gomes Martinez
- Exercise Research Laboratory, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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Assessment of Risk Factors for Falls among Patients with Parkinson's Disease. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5531331. [PMID: 34621895 PMCID: PMC8492255 DOI: 10.1155/2021/5531331] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 08/23/2021] [Accepted: 09/03/2021] [Indexed: 12/22/2022]
Abstract
Introduction The aim of this study was to assess the risk factors for falls in patients with Parkinson's disease. Materials and Methods The study comprised 53 participants (52.8% women and 47.2% men). The Hoehn and Yahr 5-point disability scale was used to assess the severity of Parkinson's disease. The Tinetti Balance and Gait Scale were used to evaluate the risk of falls. The Katz scale was used to test the independence of people with PD. The Falls Efficacy Scale-International Short Form (FES-I) was implemented to assess fear of falling. Results The majority of participants was at a high risk of falls, being at the same level for women and men. A significant relationship was noted between the risk of falls and subjective assessment of mobility (χ2 = 31.86, p < 0.001), number of falls (χ2 = 37.92, p < 0.001), independence of the subjects (χ2 = 19.28, p < 0.001), type of injury suffered during the fall (χ2 = 36.93, p < 0.001), external factors (χ2 = 33.36, p < 0.001), and the level of fear of falling (χ2 = 8.88, p < 0.001). A significant relationship also occurred between the number of falls and the fear of falling (χ2 = 33.49, p < 0.001) and between the number of falls and disease severity (χ2 = 45.34, p < 0.001). The applied physiotherapy did not reduce the risk of falls (χ2 = 3.18, p = 0.17). Conclusions Individuals who rated their mobility as good or excellent were at a low risk of falls. People who fell more times were at a high risk of falling. People more independent were at a low risk of falls. Previous injuries were the most associated with being at risk of falling. Uneven surfaces and obstacles on one's path are the external factors most associated with the risk of falling. People with low levels of fall anxiety were at a low risk of falls. Most people with low fall anxiety have never fallen. Additionally, the majority of patients with stage 1 of the disease have not fallen at all. The reason for the ineffectiveness of physiotherapy may be due to the exercise programs used and the lack of systematic implementation of them. PD is different for each patient; thus, it is important to select individually customized physiotherapy depending on motor and nonmotor symptoms, as well as general health of a patient.
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Conceição NR, Gobbi LTB, Nóbrega-Sousa P, Orcioli-Silva D, Beretta VS, Lirani-Silva E, Okano AH, Vitório R. Aerobic Exercise Combined With Transcranial Direct Current Stimulation Over the Prefrontal Cortex in Parkinson Disease: Effects on Cortical Activity, Gait, and Cognition. Neurorehabil Neural Repair 2021; 35:717-728. [PMID: 34047235 DOI: 10.1177/15459683211019344] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Since people with Parkinson disease (PD) rely on limited prefrontal executive resources for the control of gait, interventions targeting the prefrontal cortex (PFC) may help in managing PD-related gait impairments. Transcranial direct current stimulation (tDCS) can be used to modulate PFC excitability and improve prefrontal cognitive functions and gait. OBJECTIVE We investigated the effects of adding anodal tDCS applied over the PFC to a session of aerobic exercise on gait, cognition, and PFC activity while walking in people with PD. METHODS A total of 20 people with PD participated in this randomized, double-blinded, sham-controlled crossover study. Participants attended two 30-minute sessions of aerobic exercise (cycling at moderate intensity) combined with different tDCS conditions (active- or sham-tDCS), 1 week apart. The order of sessions was counterbalanced across the sample. Anodal tDCS (2 mA for 20 minutes [active-tDCS] or 10 s [sham-tDCS]) targeted the PFC in the most affected hemisphere. Spatiotemporal gait parameters, cognitive functions, and PFC activity while walking were assessed before and immediately after each session. RESULTS Compared with the pre-assessment, participants decreased step time variability (effect size: -0.4), shortened simple and choice reaction times (effect sizes: -0.73 and -0.57, respectively), and increased PFC activity in the stimulated hemisphere while walking (effect size: 0.54) only after aerobic exercise + active-tDCS. CONCLUSION The addition of anodal tDCS over the PFC to a session of aerobic exercise led to immediate positive effects on gait variability, processing speed, and executive control of walking in people with PD.
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Affiliation(s)
- Núbia Ribeiro Conceição
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Rio Claro, SP, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Rio Claro, SP, Brazil
| | - Priscila Nóbrega-Sousa
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Rio Claro, SP, Brazil
| | - Diego Orcioli-Silva
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Rio Claro, SP, Brazil
| | - Victor Spiandor Beretta
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Rio Claro, SP, Brazil
| | - Ellen Lirani-Silva
- Oregon Health and Science University, Department of Neurology, Portland, OR, USA
| | - Alexandre Hideki Okano
- Federal University of ABC (UFABC), Center for Mathematics, Computation and Cognition, São Bernardo do Campo, SP, Brazil
| | - Rodrigo Vitório
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Rio Claro, SP, Brazil.,Oregon Health and Science University, Department of Neurology, Portland, OR, USA
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Hsiao HY, Gray VL, Borrelli J, Rogers MW. Biomechanical control of paretic lower limb during imposed weight transfer in individuals post-stroke. J Neuroeng Rehabil 2020; 17:140. [PMID: 33109225 PMCID: PMC7590464 DOI: 10.1186/s12984-020-00768-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 10/06/2020] [Indexed: 01/19/2023] Open
Abstract
Background Stroke is a leading cause of disability with associated hemiparesis resulting in difficulty bearing and transferring weight on to the paretic limb. Difficulties in weight bearing and weight transfer may result in impaired mobility and balance, increased fall risk, and decreased community engagement. Despite considerable efforts aimed at improving weight transfer after stroke, impairments in its neuromotor and biomechanical control remain poorly understood. In the present study, a novel experimental paradigm was used to characterize differences in weight transfer biomechanics in individuals with chronic stroke versus able-bodied controls Methods Fifteen participants with stroke and fifteen age-matched able-bodied controls participated in the study. Participants stood with one foot on each of two custom built platforms. One of the platforms dropped 4.3 cm vertically to induce lateral weight transfer and weight bearing. Trials involving a drop of the platform beneath the paretic lower extremity (non-dominant limb for control) were included in the analyses. Paretic lower extremity joint kinematics, vertical ground reaction forces, and center of pressure velocity were measured. All participants completed the clinical Step Test and Four-Square Step Test. Results Reduced paretic ankle, knee, and hip joint angular displacement and velocity, delayed ankle and knee inter-joint timing, increased downward displacement of center of mass, and increased center of pressure (COP) velocity stabilization time were exhibited in the stroke group compared to the control group. In addition, paretic COP velocity stabilization time during induced weight transfer predicted Four-Square Step Test scores in individuals post-stroke. Conclusions The induced weight transfer approach identified stroke-related abnormalities in the control of weight transfer towards the paretic limb side compared to controls. Decreased joint flexion of the paretic ankle and knee, altered inter-joint timing, and increased COP stabilization times may reflect difficulties in neuromuscular control during weight transfer following stroke. Future work will investigate the potential of improving functional weight transfer through induced weight transfer training exercise.
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Affiliation(s)
- Hao-Yuan Hsiao
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, USA. .,Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Vicki L Gray
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - James Borrelli
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mark W Rogers
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA
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Double obstacles increase gait asymmetry during obstacle crossing in people with Parkinson's disease and healthy older adults: A pilot study. Sci Rep 2020; 10:2272. [PMID: 32042027 PMCID: PMC7010667 DOI: 10.1038/s41598-020-59266-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 01/27/2020] [Indexed: 11/17/2022] Open
Abstract
Gait asymmetry during unobstructed walking in people with Parkinson’s disease (PD) has been well documented. However, under complex situations, such as environments with double obstacles, gait asymmetry remains poorly understood in PD. Therefore, the aim of this study was to analyze inter-limb asymmetry while crossing a single obstacle and double obstacles (with different distances between them) in people with PD and healthy older adults. Nineteen people with PD and 19 healthy older people performed three conditions: (i) walking with one obstacle (Single); (ii) walking with two obstacles with a 50 cm distance between them (Double-50); (iii) walking with two obstacles with a 108 cm distance between them (Double-108). The participants performed the obstacle crossing with both lower limbs. Asymmetry Index was calculated. We found that people with PD presented higher leading and trailing toe clearance asymmetry than healthy older people. In addition, participants increased asymmetry in the Double-50 compared to Single condition. It can be concluded that people with PD show higher asymmetry during obstacle crossing compared to healthy older people, independently of the number of obstacles. In addition, a challenging environment induces asymmetry during obstacle crossing in both people with PD and healthy older people.
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